Improving tracheostomy care: National quality improvement programme

Tracheostomies are small plastic tubes that are inserted into the neck to act as artificial airways. Around 15,000 patients in England and Wales have new tracheostomies each year. These patients need competent, knowledgeable care to keep them safe as airway problems can rapidly become fatal, especially in the critically ill. In addition, the needs of patients frequently cross traditional speciality working boundaries and locations.

A Shine 2014 project, Implementing the Global Tracheostomy Collaborative (GTC) quality improvement project, involved a number of quality improvement (QI) measures being introduced into four hospitals in South Manchester. Resources included staff education, equipment provision, reorganisation of care, and involvement of patient and staff champions. The project resulted in a significant reduction in the severity of harm of tracheostomy-related patient safety incidents.

The Shine project demonstrated that it is possible to improve quality and safety of care by introducing innovative changes to the way hospitals manage these patients. This Spreading Improvement project scaled up this successful work; improving care for these high-risk patients on a national scale.

The project team worked with 20 UK secondary or tertiary care sites who were managing tracheostomy patients, and helped them to rapidly implement QI measures, thereby changing the practice and culture of tracheostomy care into patient-centred, equitable and efficient clinical care.

The project brought together work from surgeons, anaesthetists, intensive care staff, nurses, physiotherapists, speech and language therapists and importantly, work from patient groups. As a result, it reduced harm in tracheostomy patients by 55% over the 3 years of the project. Safer care led to a 20% reduction in length of stay in intensive care (ICU) and in the hospitals, and an independent economic analysis estimated huge savings for the NHS of up to £275million per year, if all NHS sites adopted the QI programme.

Recognising the importance of the work, the project has been rolled out nationally through NHS England and NHS Improvement’s National Patient Safety Improvement Programme’s ‘Safe Tracheostomy Care’ adoption and spread workstream, with similar plans in NHS Wales.

Contact information

For more information about this project, please contact Dr Brendan McGrath, Consultant in Anaesthesia and Intensive Care Medicine, University Hospital South Manchester.